Cataract surgery

[MN Blue Skies]

We should clarify that there is a big difference between Lasik surgery and Cataract surgery.  I think the OP (Rene) was talking about Lasik.  I'm sure he will correct me if I'm wrong. 

 

[Bill N]

I also take tamsulosin and have for about 8 years. There was no problem during the surgery, but I am concerned about continuing to take it. I do not know if the problem is cumulative or how wide spread it is. I, too, am going to talk to my primary physician. I was told to stop taking tamsulosin and warfarin 4 days prior to surgery. But, from John's experience, the effects might be cumulative. Now another thing to worry about.

Bill, let us know what you find out.

I sent a message to my eye doctor today - no reply yet.  I also have scoured the internet and find that tamsulosin does have an effect on vision  but the exact timing is unclear.  One source says it causes something like (as best I recall) floppy iris symptoms DURING cataract surgery but that if the surgeon knows you are taking it he can take alternative measures.  Another guy went on and on and finally he started pushing his snake oil and I dropped him right away.  Still looking but my checkup today following the laser film removal showed everything in good shape five years after the cataract surgery.  Still looking.  One note: Several sources say do not take the Tamsulosin at bedtime  (I have been) and to take it at mealtime so I will put it on the supper table from now on.

Bill

 

[UTTransplant]

We should clarify that there is a big difference between Lasik surgery and Cataract surgery.  I think the OP (Rene) was talking about Lasik.  I'm sure he will correct me if I'm wrong. 

The OP was talking about cataract surgery while Rene, the second poster, started talking about LASIK. Totally different surgeries, and this thread is a mess with both discussions happening simultaneously.

That being said, I have never met anyone who regretted cataract surgery, but I know a few who regret their LASIK. There is definitely a possibility of complications in LASIK as any decent doctor will tell you. They aren?t common, but they happen.

 

[NY_Dutch]

If you haven't had progressive lenses before do talk with your optician about the difference between them and bi- or tri-focals with lines.  Not everyone can adjust to them.  Jerry tried them and finds the ones with lines more to his liking.  I don't believe I would like them and I'm used to the lines.

ArdraF

I agree that a talk with the doctor is in order before deciding on progressive lenses. In my case, I've had progressives beginning with my first pair of glasses, and wouldn't have anything else. For my cataract surgery, I chose distance optimized lenses, thinking that I'd rather be able to drive without glasses, and my wife chose reading lenses for her surgery. I'm so used to wearing glasses all the time though, that I opted to still have progressive lenses, with the upper portion basically clear. The progressive lens gives me a good focal range from close up for fine print out to infinity that I find very useful for working at varying distances. My wife on the other hand, is constantly switching between glasses and no glasses and seems to be happy doing that.

 

[halfwright]

Thanks, Bill,

I found about the same thing.  Tamsulosin "might " cause problems in surgery in about 3% of the patients, or victims, depending on your outlook. But, I could not find anything  about what would happen down the road. The doctor that did the surgery said to go back to taking it.

 

[John Stephens]

Jim and Bill - I haven't researched the subject of Tamsulosin and/or Finasteride causing deterioration of the celluloid tissue in the body and am only going by what this specialist told me. He said that taking one or the other gives you a 3-5% chance of problems and taking both, which are usually prescribed together by most urologists, will increase the chance to 15-20% depending on your own body chemistry and how well it tolerates the drug(s). When it comes to eye problems, it seems I have always fallen into the high risk category. There is only a 4% chance of having a retina detachment when other factors are not presented. I had them in both eyes, so go figure. When he told me the second eye was a "when" rather than an "if", I assume he has already determined that if it was going to happen to me in one eye, it would affect both. Other men may not have the same issues with the drugs.

I find it interesting that you mentioned that Tamsulosin should not be taken at night. Can you tell me why? The reason I ask is because I have taken both it and Finasteride an hour or so before bedtime for a couple of years since I was having a lot of problems when getting up in the middle of the night. I mentioned this to my PCP (the same one who prescribed them without telling me the side effects) and he seemed to think taking them before bed was a good idea. I fired this guy about seven months ago, so if I find out this is another mistake on his part, it won't surprise me, but I would like concrete substantiation about when to take the drugs before confronting him with it.

MN Blue Skies - I am really sorry to hear of your LASIK experience and you are absolutely correct when you say that it is not for everyone. Some cannot tolerate it as well as needed and some simply do not have the physical traits needed for it. You're probably right about your doctor becoming a turn and burn mill if he has performed that many surgeries and cannot or will not take the time to address individual concerns regarding possible complications or poor fits. There are quite a few of them out there, just like there are good chiropractors and then there are the quacks. The doctor who performed my LASIK procedures (3 of them) was one of the five who collaborated on the first VISX LASIK machine and was named one of the top 100 doctors in the country for many years. I got lucky again with my present refractive surgeon who repositioned my IOLs this year, with him being another who has been named in the top 100 every year since 2003. Both of these doctors are pioneers in their field and are good enough to know the possible complications a patient may have depending on how their eye may respond. I got my LASIK procedures for the sole reason of getting my vision back to what it was before the detachments occurred, since the scleral buckles they put around the eyeball to squeeze the retina back into place elongate the eyeball, which creates an automatic near sightedness. After having several surgeries on each eye, I didn't want to settle for having to wear glasses or contacts again; hence, the LASIK. I have also had my problems with it with halos around lights at night being the biggest issue, and that is why I limit my driving at night to cars only. I have driven my coach at night three times in three years, only when absolutely necessary. Being up high gives me a much better view of what is in front of me, but trying to see what's behind me in the mirrors can be difficult at best and nearly impossible at worst. When we are on vacation, this doesn't present a problem since we are usually off the road by 3-5 PM anyway. I have never had a problem with depth perception since getting mono vision, possibly because the two visions are close enough together. Now, since I had the left lens repositioned and the doctor wasn't able to put it back in its proper focal point, giving me 20/60-20/100 variable vision (the eye is damaged from the detachment so the vision varies all the time), when I wear a contact in the right (distance) eye to get the vision from 20/30 down to 20/20, I have a difficult time blending the two together because sometimes they are simply too far apart for the brain to compensate. When that happens, I lose my depth perception entirely. But if I wear contacts in both eyes so the right is seeing 20/20 and the left is seeing 20/40, I have no problems at all with either blending or depth perception. I'm waiting until six months after the last surgery to go back and have the doctor give me LASIK on the left (reading) eye for the third time so I don't have to wear contacts. I can get by with 20/30 in the distance eye most of the time, only really needing it when driving the coach and having the need to see as far in front as possible. Legally, as long as one eye sees 20/40, you're all right in most states, if not all.

 

[Bill N]

The OP was talking about cataract surgery while Rene, the second poster, started talking about LASIK. Totally different surgeries, and this thread is a mess with both discussions happening simultaneously.

That being said, I have never met anyone who regretted cataract surgery, but I know a few who regret their LASIK. There is definitely a possibility of complications in LASIK as any decent doctor will tell you. They aren?t common, but they happen.

You are correct.  We are starting to get apples and oranges mixed here.  Need to be clear which we are talking about. 

Bill

 

[Bill N]

Thanks, Bill,

I found about the same thing.  Tamsulosin "might " cause problems in surgery in about 3% of the patients, or victims, depending on your outlook. But, I could not find anything  about what would happen down the road. The doctor that did the surgery said to go back to taking it.

Thanks Jim.  I tend to get overexcited about stuff like this. But like you I have been taking the stuff for years and have only noticed one side effect and that one could also be caused by age......lol.

Bill

 

[Bill N]

I find it interesting that you mentioned that Tamsulosin should not be taken at night. Can you tell me why? The reason I ask is because I have taken both it and Finasteride an hour or so before bedtime for a couple of years since I was having a lot of problems when getting up in the middle of the night. I mentioned this to my PCP (the same one who prescribed them without telling me the side effects) and he seemed to think taking them before bed was a good idea. I fired this guy about seven months ago, so if I find out this is another mistake on his part, it won't surprise me, but I would like concrete substantiation about when to take the drugs before confronting him with it.

John, I was always taking it at bedtime along with one other drug but in doing the small bit of research I find that they recommend it be taken with the evening meal so I guess that they prefer to have it dissolve with food.  It always is amazing how many side effects that drugs can have and probably one of the good things the government has done is make it mandatory to disclose them to the user.  I sometimes laugh at the TV drug adds where they side effects go on longer than the positive points of the med.  Some even include "death" as a side effect.  I bet they cringe when they have to include that.  I just changed my timing to taking Tamsulosin with the meal and hope that means that I can drain a lot of fluids before I go to bed (and not get up at 3AM).
It doesn't help that we have a new pup who until only recently was getting me up at 2 am and 4 am and I was heading to the bathroom also at midnight.  As the pup has grown to only one 5 am trip, I am also down to one trip per night.....lol

Bill

 

[Rene T]

The OP was talking about cataract surgery while Rene, the second poster, started talking about LASIK. Totally different surgeries, and this thread is a mess with both discussions happening simultaneously.

I want to apologize. I'm learning everyday and I didn't know there was a difference. I was mistaken when the lasik center I went to would do the surgery by implanting a lense. But I opted to wait because of the cost. So I thought the procedures were the same. Sorry everyone. Please, no more talk about LASIK. Someone start another post if they want to talk about LASIK.

 

[John Stephens]

John, I was always taking it at bedtime along with one other drug but in doing the small bit of research I find that they recommend it be taken with the evening meal so I guess that they prefer to have it dissolve with food.  It always is amazing how many side effects that drugs can have and probably one of the good things the government has done is make it mandatory to disclose them to the user.  I sometimes laugh at the TV drug adds where they side effects go on longer than the positive points of the med.  Some even include "death" as a side effect.  I bet they cringe when they have to include that.  I just changed my timing to taking Tamsulosin with the meal and hope that means that I can drain a lot of fluids before I go to bed (and not get up at 3AM).
It doesn't help that we have a new pup who until only recently was getting me up at 2 am and 4 am and I was heading to the bathroom also at midnight.  As the pup has grown to only one 5 am trip, I am also down to one trip per night.....lol

Bill

Bill - Good to hear your nightly trips are reducing for both reasons. We just got a 4 yr old rescue smooth Collie that has to remain crated at night and he wakes us up about an hour before we want to get up every morning. But at least he stays quiet throughout the night most of the time, only barking when he hears something outside. Our 20 month old rough Collie is good for the entire night.

I have always been fortunate in being able to limit my nightly trips to the bathroom to only one or two. But before I began taking the drugs right before bed, it would take me 20 minutes before being able to return to bed. Now, it's more like 5-10 minutes. About once every two years, I get so tired from lack of sleep that I don't wake up for seven hours and sleep straight through. That's one of the reasons I don't drive OTR anymore and take extra care when driving the coach, especially at night. And it doesn't seem to matter which bed I'm in - while on the road in the coach, there is no change. Every four hours, I'm up.

 

[Bill N]

I did receive a reply from my eye doctor regarding the Flo-Max/Tamsulosin question I asked.  Here it is:

"Tamsulosin does have ocular side effects, however, it affects the iris and not the zonules. This is important during cataract surgery which you already had 5 years ago. The smooth muscle dilator of the iris becomes affected, and the pupil will often not dilate well complicating cataract surgery. The zonules do hold the lens capsule/bag in place but I have never heard of Flomax affecting the zonules. A quick search into the medical literature did not present any reports of this either. I think you are perfectly fine using Flomax at this time since you already had cataract surgery in both eyes. Let me know if you have any further questions."

I will continue my Tamsulosin as I quit only a few days ago and am not seeing an effect in very slow urination.



Bill

 

[halfwright]

Bill,

Thank you for the information.

 

[John Stephens]

Bill - I have always found it interesting that you can ask 10 doctors for an opinion, theory or fact regarding a subject and get 10 different answers. Accordingly, I have always maintained the opinion that medicine is more of an art than a science. I cannot argue with what your doctor told you because I honestly don't know if he is right or if my doctor is correct. I can, however, tell you that my doctor predicted the deterioration of the zonules in the second eye prior to the surgery performed on the first eye due to my use of alpha blockers and he was correct. Was it a lucky guess? Maybe. Or maybe he knows something that other doctors do not because of his research. I'm not going to say he is right and your doctor is wrong, but my results speak for themselves. I certainly would not change your lifestyle if your doctor tells you it isn't necessary.

Thank you for checking this out. I am always open to other opinions that may influence my own thinking.

 

[Bill N]

Bill - I have always found it interesting that you can ask 10 doctors for an opinion, theory or fact regarding a subject and get 10 different answers. Accordingly, I have always maintained the opinion that medicine is more of an art than a science. I cannot argue with what your doctor told you because I honestly don't know if he is right or if my doctor is correct. I can, however, tell you that my doctor predicted the deterioration of the zonules in the second eye prior to the surgery performed on the first eye due to my use of alpha blockers and he was correct. Was it a lucky guess? Maybe. Or maybe he knows something that other doctors do not because of his research. I'm not going to say he is right and your doctor is wrong, but my results speak for themselves. I certainly would not change your lifestyle if your doctor tells you it isn't necessary.

Thank you for checking this out. I am always open to other opinions that may influence my own thinking.

Totally agree with you John.  I don't know a zonule from a hole in the ground but we have to rely on somebody or some bit of information on just about everything in life.  For now, I am back on the Tamsulosin as I had started to revert to the long duration at the urinal problem.  Kicked me right back into high flow.......lol  Thanks John.

Bill

 

[HueyPilotVN]

Totally agree with you John.  I don't know a zonule from a hole in the ground but we have to rely on somebody or some bit of information on just about everything in life.  For now, I am back on the Tamsulosin as I had started to revert to the long duration at the urinal problem.  Kicked me right back into high flow.......lol  Thanks John.

Bill

Since the conversation has turned to the subject of Zonules I thought I would supply a little insight, (pun intended), about Zonules.

When I started assisting in Cataract Surgery in the early 70's, the older normal procedure was to remove the Lens, (cataract) intact from the eye through a fairly large opening made by using a scalpel to make an incision around the Cornea for almost half of the upper perimeter of the eye.

This large opening was needed to remove the lens with the capsule intact.  After making the incision but prior to removing the lens we would inject an enzyme solution called "Alpha Chymar" into the eye.  This solution would dissolve the Zonules.  Maybe a better word for the Zonules would be "Ligiments". 

The earlier version of Cataract Surgery definitely required two people to perform different functions during surgery.  My job was to pull back the Cornea with a suture to create a large opening while the surgeon would touch a freezing probe to the lens to create an icy attachment and then deliver the intact lens thru the opening after the Zonules had been dissolved.

The Zonules have more than one function.  They do hold and position the lens in place just behind the Iris and centered in the eye.  They also control the shape of the lens by pulling on the edge of the lens to change the refractive power of the lens allowing you to focus up close or far away.  This ability is greatest when young and is reduced as we age.  That is the reason that we lose the ability to focus up close as we get older.  The lens is not as pliable and the zonules do not have as much effect.  The removal of the natural lens with it's ability to change focus is also why we need readers, bifocals, or one eye near and one eye far solutions.

Just thought you might like a little more information about Zonules.

 

[halfwright]

Bill,

If I carry this line of thought another step, the zonules are not attached to the new inserted lens.  So, if the tamsulosin did dissolve them, it would have no affect on the new lens.  Or am I missing something?

 

[HueyPilotVN]

Jim,

Different IOLs, (Intraocular Lens) are held in place with sometimes different mechanisms.  The early Implants were placed with feet or extensions that fit in front and behind the iris.  You have to remember that the old style surgery removed the entire lens with the capsule, (outer covering) intact by dissolving the zonules.

The newer and better type of surgery uses a very much smaller incision and removes the cloudy contents of the lens in small pieces while leaving the outer back and side layers of the capsule attached to the zonules.

I was just trying to describe what the Zonules are.

If the implant is in the bag, (remaining capsule) then you would certainly want the zonules to remain attached.

 

[John Stephens]

Yes, zonules are used for accommodation, which is the ability to see near or far, by stretching or compressing the lens to change its shape and accordingly, it focal point. And with the newer cataract surgeries, the zonules are not dissolved or removed unless necessary to access the lens. When I had my cataract surgeries done in 2000, my surgeon used a method unknown to me to break the old lens into small fragments and then suction them out of the capsule. He then inserted the new IOL which had springy "feet" on them that would attach themselves to the inside of the capsule. The trick is to get the IOL in the correct position, something a competent surgeon with plenty of experience can do without problem.

If you have no zonules, there is no way for the capsule containing the lens, whether the original or an IOL, to stay in place, because the zonules are what keeps the lens from falling into the retina. That is what my problem was - my zonules dissolved. My left eye always had 25% of the zonules missing, discovered by my surgeon when he did the cataract surgery on that eye. Interestingly, when the latest surgeon did the repositioning procedure, there were still roughly 50% of the zonules remaining, having caught the problem in time. The right eye, however, had 97% of its zonules dissolved by the time we did the surgery, which is what made it an emergency procedure, performed 48 hours after it was diagnosed.

I misspoke when I said that zonules are made of celluloid. That would make it sound like old movie film. They are a cillial material, not quite muscle and not quite ligament, but as Huey noted, they can be considered ligament. They are flexible enough to be able to tighten or loosen to change the shape of the lens in its capsule.

As far as the Alpha blocker medications I am taking - Tamsulosin and Finasteride - I never stopped taking them after being told by my doctor that they were causing the problem because I knew it was only going to be a matter of time before the other eye needed attention. And if I stopped taking them, my urinary problems would become severe.

 

[Bill N]

What a forum!  Where else on the internet can you find out how to clean out a black tank, decide which RV park to stop at in Indiana, determine if you have a slide problem and have an indepth discussion of zonules? The RV Forum is tops and while I am not fully understanding AAZ (all about Zonules), I sure am happy to read and get the gist of what they do and how they affect the eye.  Meanwhile, I am happy to report that my flow is normal and my vision is about as good as it is going to get in the future.  Thanks folks for all of the information on this forum.  I never feel hesitant to ask a question as I now know there are others out there who have the answers or at least suggestions as to what the problem may be.  Lately this thread and another on oxygen concentrators have increased my knowledge of things important in my life.  Let's keep on keeping on and thanks to Tom and all the moderators for keeping this train on the tracks.

Bill